Characteristics and results of surgery for residual esotropia

Residual esotropia (RE) is a postoperative complication with a prevalence of 20% after surgery for childhood esotropia.

To study the characteristics and efficacy of different surgical techniques in reoperations on subjects with residual esotropia.

Retrospective study of 34 cases with residual esotropia between 2017-2024. The mean age was 33.12 years, 52.94% women. The mean time between initial surgery and reoperation was 16.3 years. Data were collected from the alternating prism cover test, TNO and Worth tests, limitations in ductions, and alphabetical pattern. Success was considered a residual deviation <10 prism diopters without diplopia. The mean follow-up time was the period from the first surgery to data collection: 18.26 years.

A total of 46 surgeries were performed: re-recession of the medial rectus (19.15%), lateral rectus resection (44.68%), or both techniques combined (36.17%), uni- or bilaterally. The mean number of reoperations was 1.38 (range,1-3), with one case requiring three surgeries. The surgical technique with the best outcome was the re-recession of the medial rectus muscles (87.5%), followed by combined surgery (64.7%) and resection of the lateral rectus muscles (52.4%). No statistically significant differences were found between the surgical techniques analyzed.

Medial rectus re-recession was the most effective technique for correcting residual esotropia compared to lateral rectus resection or a combination of both. No predictors of surgical success were found.